Lecture 1- Gastrointestinal Pathology 1 Flashcards
…. …. can precede onset of lower GI disease, be present during GI disease, can persist after or reflect systemic alterations secondary to GI disease such as those seen with malabsorption
oral manifestations
the parotid gland is mainly ….
serous acni
sublingual glands are mainly …
mucous acini
submandibular and minor glands are mainly…
neither, they are mixed
What is the autoimmune disease that usually occurs in females 30s-50s that present with dry mouth and eyes (keratoconjunctivitis sicca) and intense lymphocytic infiltrate that replaces glandular tissue
Sjogren syndrome
Sjogren syndrome has an …. increased risk for lymphoma
40x
you can see a uni or bilateral enlargement in the parotid gland in … syndrome
sjogren
how often is sjogren syndrome secondary as opposed to primary?
60% of the time and occurs in setting of other autoimmune diseases
…% of salivary gland tumors are of the … gland and … of those are benign
75%
parotid
75%
2 types of benign salivary gland tumors
pleomorphic adenoma
warthrin tumor
most common malignant salivary gland tumor?
mucoepidermoid carcinoma
pleomorphic adenoma occurs …% of the time in the parotid
60%
T/F pleomorphic adenomas are lobulated and firm on palpitation
true
there is …% of recurrence with pleomorphic adenomas
10%
Can pleomorphic adenomas undergo malignant transformations?
yes
warthin tumor occurs only in the …. gland
parotid
T/F females are mostly affected my warthin tumors
false
…% of warthin tumors are bilateral
10%
warthin tumors are associated with…
smoking
where can mucoepidermoid carcinoma occur?
parotid and minor glands
what condition can there be a bluish color due to mucin and cystic growth pattern
mucoepidermoid carcinoma
… means the inability of the lower esophageal sphincter to relax
achalasia
esophageal obsrtuctions can be … or …
mechanical- post inflammatory fibrosis or stenosis
functional- discoordinated muscular contractions
… … can arise due to portal HTN and is seen in 90% of cirrhotic patients
esophageal varices
Are esophageal varices symptomatic or asymptomatic?
asymptomatic but can rupture and lead to a massive hemorrhage/death
extrinsic agents of esophagitis?
chemicals iatrogenic infections trauma smoking
intrinsic agents of esophagitis
reflux (GERD)
acids, smoking and pill lodging are examples of … agents of esophagitis
extrinsic
chemo, radiation and graft vs. host diseases are examples of … agents of esophagitis
iatrogenic
fungal and viral causes of esophagitis are … agents and are more common in immuno-compromised patients
infectious
… esophagus is a complication of GERD with increased risk of adenocarcinoma
Barret
T/F despite increased risk, most people with barrets do NOT develop tumors?
true
… esophagus is intestinal metaplasia within the esophagus squamous mucosa
Barret
2 diagnostic features for Barrett esophagus
- extension of abnormal mucosa above gastro-esophageal jxn
2. demonstration of squamous metaplasia
… may be seen in patients with chronic gastric reflux (GERD, hiatal hernia, alcoholism and bulimia)
gastric acid enamel erosion
enamel loss often affects which surfaces?
lingual/palatal
extent of enamel loss in GI reflux may result … or …
duration
frequency
2 benign esophageal neoplasms are?
leiomyoma
mucosal polyps
esophageal malignancies account for …% of all GI cancer
8%
2 types of malignant tumors in the esophagus
adenocarcinoma (barret)
squamous cell carcinoma
squamous cell carcinoma is associated with … and … use
smoking
alcohol use
SCC: tends to occur in males …:1 and especially african americans …:1 vs. white males
4: 1
6: 1
what is the 5 year survival of Squamous Cell Carcinoma?
9%
Adenocarcinoma is associated with … and tends to occur in males …:1 and is often detected late and has a …% 5 year survival rate
GERD
7:1
25%
SCC occurs mostly in the … of the esophagus
middle third
SCC has regional variation so it is most common where?
this may be due to geentics, environment or diet
china, brazil, south africa
what can increase risk for SCC
dietary- vitamin def., fungal contam of food, nitrates and nitrosamines
SMOKING and alcohol
Plummer Vinson, achalasia, esophagitis
which is more common worldwide? SCC or adenocarcinoma?
SCC
adenocarcinoma usually affects the …. of the esophagus
distal third
are caucasians or african americans more affected by adenocarcinoma?
caucasians
autoimmune gastritis (which is chronic) is loss of the … cells which pump out acid. this leads to decreased … and decreased …. absorption which is … anemia
parietal
intrinsic factor
B12
pernicious
what can cause acute gastritis
cigarettes, alcohol, stress, ischemia, NSAIDs, aspirin, infection
symptoms of acute gastritis?
asymptomatic to epigastric pain to hemorrhage
main cause of chronic gastritis?
infection, 90% of cases (helicobacter pylori)
treatment of chornic gastritis caused by helicobacter pylori?
antibiotics and proton pump inhibitors
what can cause peptic ulcer disease?
H.pylori, NSAID use
peptic ulcer disease is …% duodenum or stomach
98%
peptic ulcer disease: lifetime risk for males …% , lifetime risk for females …%
10%
4%
peptic ulcer disease involves gastric … and recurrent … with intermittent …
hyperacidity
ulcers
healing
peptic ulcer complications
intractable pain
hemorrhage
perforation (5%)
obstruction-edema, fibrosis (2%)
4 causes of small intestine malabsorptive diarrhea
celiac disease: gluten allergen
tropical sprue
lactate deficiency
abetalipoproteinemia
in caucasians, about 1 in…. have gluten sensitivity
100-200
gluten sensitivity is actually a hypersensitivity to ….
gliadin
morphology of gluten sensitivity
blunted villi
inflammatory infiltrate
T/F symptoms of gluten sensitivity dramatically improve with withdrawal of wheat gliadin and related grain proteins from diet
true
odynophagia is … and is a symptom of esophagitis along with dysphagia, heartburn and regurgitation of gastric contents
pain on swallowing
…% of chronic gastritis cases are autoimmune (pernicious anemia)
10
… is a curved gram-negative bacillus seen in most cases of chronic infectious gastritis
Helicobacter pylori
… is a cause of small intestine malabsorptive diarrhea and it is a defect in transepithelial transport of mono and triglycerides
abetalipoproteinemia
clinical aspects of malabsorption
anemia
osteopenia, tetany
amenorrhea, impotence, infertility
peripheral neuropathy, nyctalopia (decreased vit. A)
…. results from malabsorption of any of the following: iron, pyridoxine, folate, B12, vit. K
anemia
…. can result from malabsorption of Ca, Mg, vit D and protein
osteopenia, tetany
…,…., and … can result from generalized malnutrition
infertility
impotence
amenorrhea
… and … can result from malabsorption of vit. A and B12
peripheral neuropathy
nyctalopia (night blindness)
if malabsorption is severe, initial oral sign is
atrophic glossitis (bald, reddish tongue)
oral manifestations of malabsorption:
overt tongue lesions are usually….. and burning sensation (…) is a common complaint
tender
glossopyrosis
